COWS — Opioid Withdrawal Scale
Clinical Opiate Withdrawal Scale. Guides buprenorphine induction timing and severity monitoring.
Score interpretation
Score 0–4
→ Monitor; not in sufficient withdrawal for buprenorphine induction
Score 5–12: Mild opioid withdrawal
→ Symptomatic management; buprenorphine induction can begin at score ≥8–12
Score 13–24: Moderate opioid withdrawal
→ Buprenorphine induction indicated; continue dose titration
Score ≥25: Moderately severe to severe withdrawal
→ Prompt buprenorphine/methadone treatment; supportive IV fluids if needed
Interpretation bands for the COWS. Apply clinical judgement and local guidance.
References
- Wesson DR, Ling W. The Clinical Opiate Withdrawal Scale (COWS). J Psychoactive Drugs. 2003;35(2):253-259.
Related
Curated clinical cross-links plus same-class fallbacks.
- Buprenorphine · Opioid partial agonist (μ-receptor partial agonist, κ-antagonist)
- Buprenorphine (Opioid Dependence) · Partial Opioid Agonist (Opioid Substitution Therapy)
- Buprenorphine / Naloxone (Sublingual) · Opioid Partial Agonist — Opioid Substitution Therapy (OST)
- Clonidine · Alpha-2 Adrenoceptor Agonist (ADHD / Opioid Withdrawal / Tic Disorders)
- Buprenorphine with naloxone · Partial mu-agonist + opioid antagonist (opioid dependence)
- Buprenorphine (Surgical — Analgesia) · Opioid Analgesic (Partial Agonist)
- Acute Behavioural Disturbance / Rapid Tranquillisation · RCEM 2022; RCPsych 2022; NICE NG10
- Self-Harm Presentation · NICE NG225 (2022)
- Capacity Assessment (Mental Capacity Act) · MCA 2005; Code of Practice
- Acute Psychosis Management · NICE CG178 2014
- Depression Management · NICE CG90 2022
- Lithium Therapy Monitoring · NICE CG185
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.